Agenda and minutes

Councillor Anderson declared a non-pecuniary interest in Minute AD11 below, as an employee of the Tees, Esk and Wear Valley NHS Foundation Trust.

RESOLVED – That the Minutes of the Ordinary Meeting of this Committee held on 20 June 2023, be approved as a correct record.

Presentation from Sandra Sutton (Operations Manager, Network North, Care Quality Commission) and David Ross (Operations Manager, Network North, Care Quality Commission).

Sandra Sutton and David Ross, Operations Managers, Network North, Care Quality Commission (CQC), gave a presentation on the role and purpose of the CQC, and provided an overview of how the CQC will be registering, monitoring, inspecting and rating in the future, in light of the reforms outlined in the Health and Care Act 2022.

Members were informed that the changes would allow the CQC to provide greater focus on care across local areas or systems, use the new regulatory powers effectively to improve people’s care, make regulation less complex and more efficient, regulate in a smarter way, and work better with the sector as it also changes. It was stated that the new approach would embrace new technology, the adoption of a new Single Quality Assessment Framework for all service types and at all levels, the introduction of multidisciplinary teams, and use new powers to review and assess Integrated Care Systems and local authorities.

Particular focus was given to the development of the Single Quality Assessment Framework, which was being introduced to replace the four separate frameworks currently adopted, and would be used to assess all service types. It was noted that the ratings and five key questions would remain central to the CQC’s approach, however the existing key lines of enquiry and prompts would be replaced with ‘quality statements’, and that the CQC was moving away from separate monitor, inspect and rate steps, assessing providers in a more flexible way.

Members were advised on the interim guidance, subject to Government approval, which set out the high level framework for the oversight of local authorities, focusing on an initial baselining period. The four themes which would provide the initial focus of local authority assessments were outlined, together with the two quality assessments, and Members were provided information on the five pilot assessments that were currently taking place. Similar information was also provided in relation to the assessment on Integrated Care Systems.

Members entered into discussion on the level of influence local authorities had on private contractors within the Care Sector, and how the Single Quality Assessment should assist with the strive for consistency, and Members questioned how consistent rating in the past could have been achieved without a Single Quality Assessment. Members questioned whether the methodology of the Single Assessment Framework could be manipulated, but were reassured that the focus would always remain on the fundamental standard of care, and observed that the pilot authorities did not necessarily reflect the situation in Darlington. 

Discussion continued on the pilot process for the Single Assessment Framework, and it was acknowledged that the Framework would evolve throughout the pilot process, as would the way in which the CQC reported its findings.

Focus turned to the Integrated Care System assessments, and Members were keen to learn more on how the CQC would compare equity of access and ensure consistency, and there was a recognition that there would be a need for place benchmarking.

RESOLVED – That the content of the presentation be noted.  ...  view the full minutes text for item AD10

Presentation from Martin Short, Director of Place, North East and North Cumbria Integrated Care Board (ICB), and Dominic Gardner, Care Group Director MHSOP / AMH, Durham Tees Valley Care Group, Tees, Esk and Wear Valleys NHS Foundation Trust.

Members received a presentation on the Autism Strategy from the Assistant Director – Adult Services, the Director of Place, North East and North Cumbria Integrated Care Board (ICB), the Care Group Director, Durham Tees Valley Care Group, Tees, Esk and Wear Valley NHS Foundation Trust (TEWV), and colleagues from the Tees, Esk and Wear Valley NHS Foundation Trust.

Members were initially provided with an overview of the national context, including the range in terms of the level of support required, the legal obligations and the statutory framework, and the overall costs associated with Autism, before receiving information on the context in relation to Darlington, which included TEWV diagnostic waiting times, and the number of cases within Adult Social Care, broken down by primary support reason.

The six priority areas of focus for the strategy were outlined, namely Improving Understanding and Acceptance of Autism with Society; Improving Services for Autistic Children and Young People, Access to Education and Supporting Positive Transitions into Adulthood; Supporting More People into Employment; Tackling Health and Care Inequalities for Autistic People; Building the Right Support in the Community and Supporting People in Inpatient Care; and Improving Support into the Criminal and Youth Justice Systems, and detailed actions alongside each priority area were discussed.

The presentation concluded with a number of recommendations and actions that were taking place throughout 2023.

Members entered into discussion on the diagnostic waiting times, noting 46 cases where the waiting time for diagnosis exceeded more than 12 months, and questioned the frequency of contact during the waiting period and enquired whether targets were met. Members were interested to learn whether there were sufficient assessors to meet demand, and the length of time it took an individual to qualify as an assessor. Discussion progressed on to the nature of assessment, and Members were keen to know how long the assessment process took.

Focus then turned to the training and support available to those staff and carers who care for people with autism.

Discussion returned to the support offered following an autistic diagnosis, with an acknowledgement that support had not always been as forthcoming in the past, however it was recognised that there was now much greater awareness and a developing cultural change, with greater training available and the provision of a service offering reasonable adjustments personal to the individual, though it was suggested by Members that some services could be cost prohibitive.

Concerns were raised that not all cases were being signposted to the correct support, or were being addressed by practitioners who had not received appropriate autism awareness training. It was also suggested that young girls and young women were ‘masking’, and that there was a need for greater diagnosis in this cohort. Members were reassured that there was a greater awareness around autism in women and teenagers, however Members were advised that if they were aware of negative experiences this should be fed back and practice reflected upon.

It was noted that this work cut across the remit of three of  ...  view the full minutes text for item AD11

Presentation from Diane Encinias, Nursing Care Home Manager, Ventress Hall Care Home

Members received a verbal presentation from Diane Encinias, a Care Home Manager at Ventress Hall Care Home in Darlington. Ms. Encinias provided the Committee with the view of a front-line manager, providing an overview of what it was like to work in a Care Home during the Coronavirus pandemic which resulted in the greater use of new technology, closer working relationships with the Council’s Contracts Team, and a greater appreciation and understanding of other roles within the Care Sector.

Ms. Encinias suggested that workloads remained high following the Coronavirus pandemic, and whilst the greater use of technology assisted, there was still an emphasis on face-to-face contact with service users and families.

Members observed that there still seemed to be a number of constraints around service provision, and speculated as to whether this was still a fall out from the Coronavirus pandemic or the current high cost of living. Ms. Encinias stated that she was fortunate to work for one of the larger care providers and therefore did not necessarily recognise this herself, however believed that some of the smaller care providers might notice the challenges to their budgets.

Members were keen to understand whether there were any practices introduced during the Coronavirus pandemic that improved service delivery, and whilst the technological and communication improvements were welcomed, Ms. Encinias was keen that the focus remained on person-centred care.

Discussion ensued on the issues in relation to recruitment and retention within the Care Sector, and the training opportunities available for staff, both to upskill at the current level and to progress within the sector, and whether organisations and care settings shared training and good practice.

RESOLVED – That the content of the presentation be noted.    

Presentation from the Head of Commissioning and Contracts

The Head of Commissioning and Contracts provided Members with a presentation on the quality and contract monitoring of Care Homes, and the support provided by Adult Services in relation to the Executive Strategy Management (ESM) process.

The Head of Commissioning and Contracts advised Members on the development of an Executive Strategy Management Action Plan, and the themes contained within such plans, which have previously included Management and Leadership of Care Home, Culture, Recruitment and Retention practices, Safety and Welfare of Residents, Staff Training and Development, Management of Medication and Poor Record Keeping.  

Members were advised of the number of Executive Strategy Management interventions over the course of 2021/22, 2022/23 and 2023/24 to date, and provided with the most recent ratings by the CQC for the Care Homes in Darlington.

Discussion ensued on the appropriate utilisation of staff within Care Homes, the spike in ESMs in 2022/23 and the lessons learnt, and the consequences and reparations attached to ESM. Members were keen to understand how the Council ensured that self-funders continued to receive the same level of care should a contractual breach lead to a reduction in fees payable from the local authority, and what timescales were involved to improve if the CQC deemed services to be inadequate or required improvement.

RESOLVED – That the content of the presentation be noted.  

Report of the Assistant Director, Law and Governance

The Assistant Director, Law and Governance submitted a report (previously circulated) requesting that consideration be given to this Scrutiny Committee’s Work Programme and to consider any additional areas which Members would like to suggest should be included in the previously approved Work Programme.

RESOLVED – (a) That, in light of the All-Member Briefing arranged for 14^th September 2023 on the same subject, the item entitled ‘Substance Misuse Service Update: Support Treatment and Recovery In Darlington through Empowering (STRIDE)’, be deferred from the Ordinary Meeting of this Committee on 24 October 2023, and provisionally re-scheduled for the Ordinary Meeting of this Committee on 9 January 2024.

(b) That a report entitled ‘Annual Older Persons Quality Standards’ be added to the Work Programme, and scheduled for the Ordinary Meeting of this Committee on 24 October 2023. 

(c) That the Work Programme, including the above amendments, be noted.